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目的总结婴幼儿先天性心脏病心内直视手术中的体外循环管理技术与方法。方法回顾该院2006年3月至2009年12月208例婴幼儿先心病术中体外循环情况,根据患儿血色素计算加入适量的新鲜浓缩红细胞,预计稀释后血球压积(HCT)为20%～25%,预充液总量为640～900ml,晶胶比为0.06～0.60。心肌保护以低温、主动脉根部顺行灌注为主,其中4:1含氧血灌注160例,冷晶体灌注40例,不停跳5例,首次灌注剂量20～30ml/(kg.min),间隔20～30min复灌注半量,灌注压<50mmHg。对低体重、病情重患儿常规安装改良超滤装置,在停机后实施改良超滤10～15min提高血经蛋白至9%～10%。维持术中平均动脉压在30～80mmHg,平均(56.3±9.2)mmHg,过高时采用加深麻醉及应用少量扩血管药物,防止微循环灌注不足。结论婴幼儿体外循环有其特殊性,根据患儿的病情制定周密的灌注计划,选择适宜材料和灌注方式,着重心肺保护,同时运用超滤技术,对提高术后成功率起着重要作用。
Objective To summarize the techniques and methods of cardiopulmonary bypass in infants with open heart surgery under congenital heart disease. Methods From March 2006 to December 2009, 208 cases of infantile cardiopulmonary bypass during cardiopulmonary bypass were retrospectively analyzed. According to the hemoglobin of children, appropriate amount of freshly concentrated erythrocytes was added. The estimated hematocrit (HCT) after dilution was 20% 25%, the total amount of pre-filled liquid is 640 ~ 900ml, crystalline rubber ratio is 0.06 ~ 0.60. Myocardial protection mainly consisted of hypothermia and aortic root antegrade perfusion, including 160 cases of 4: 1 oxygenated blood perfusion, 40 cases of cold crystal perfusion, 5 cases of constant beating, and the first perfusion dose of 20-30 ml / (kg · min) Interval of 20 ~ 30min reperfusion half a dose, perfusion pressure <50mmHg. On low weight, severe illness, children with conventional installation of modified ultrafiltration device, the implementation of improved ultrafiltration shutdown 10 ~ 15min to improve blood protein to 9% to 10%. To maintain intraoperative mean arterial pressure at 30 ~ 80mmHg, an average of (56.3 ± 9.2) mmHg, too deep anesthesia and the application of a small amount of vasodilator drugs to prevent microcirculation perfusion. Conclusion Infantile extracorporeal circulation has its own particularity. According to the condition of children, careful perfusion planning, appropriate material selection and perfusion method, focusing on cardiopulmonary protection, and using ultrafiltration simultaneously, play an important role in improving postoperative success rate.